Administrator Medal 2025

NORTHERN TERRITORY ADMINISTRATOR’S MEDAL AWARD

For exceptional contribution to Lifesaving, Water Safety and Drowning Prevention in the Northern Territory

Nomination Form

Nominee Details

Full name *

Address *

Street address *

City *

State *

Postcode *

Email Address *

Mobile *

Nominator Details

Nominated by *

Mobile *

Email Address *

Signature *

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Date

Referee Name 1 *

Referee Name 2

Contact Details *

Contact details 2

Citation

Outstanding Community Service in Water Safety – Nomination Questions

1. How has the nominee contributed to lifesaving or water-safety programs, including any participation in training, education, patrols, or competitions? *

2. What club memberships, affiliations, or formal involvements has the nominee held within the Northern Territory’s aquatic or lifesaving community? *

3. Has the nominee received any awards or recognition, or participated in relevant competitions or events that highlight their contribution to lifesaving or water safety? *

4. In what ways has the nominee demonstrated outstanding citizenship, volunteerism, or care for others through their actions in the community? *

5. How has the nominee’s work contributed to drowning prevention, community wellbeing, or water safety outcomes that benefit the Northern Territory? *

Further Information

Nominations Open: 25 November 2025

Nominations close: 25 January 2026, 4pm

All Nominations to be submitted online with JPEG photo and or 1 minute video of the nominee

Return the completed nomination form to: Membership Officer, Royal Life Saving Society (Australia) NT Branch Inc (preferred option email: financent@rlssa.org.au ) or via post to: GPO Box 1229, Darwin NT 0801

Image upload *

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